E78.41 ICD-10-CM Code: Elevated Lipoprotein(a)
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)
E78.41
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceElevated Lipoprotein(a)
A condition where there are elevated levels of lipoprotein(a), a type of cholesterol-carrying protein in the blood that increases the risk of heart disease and stroke.
Buddy Insight
Elevated Lipoprotein(a), or Lp(a), is an emerging independent risk factor for atherosclerotic cardiovascular disease and calcific aortic valve stenosis.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 47
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Elevated Lp(a)
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E78.41 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E78.41 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E78.41 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E78.41 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E78.41 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E78.41 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is E78.41 an HCC code?
No. E78.41 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for E78.41
For E78.41to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E78.41 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
E78.41 is the ICD-10-CM diagnosis code for elevated lipoprotein(a). A condition where there are elevated levels of lipoprotein(a), a type of cholesterol-carrying protein in the blood that increases the risk of heart disease and stroke. E78.41 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).
E78.41 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
E78.41 maps only to RxHCC 47 (Disorders of Fatty-Acid and Amino-Acid Metabolism) with no RAF weight. No V24 or V28 CMS-HCC mapping. Despite growing recognition as a cardiovascular risk factor, elevated Lp(a) does not impact Medicare Advantage risk adjustment scores.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E78.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific lipoprotein(a) level if available to support medical necessity
- •This code is used when lipoprotein(a) is elevated as a standalone finding, separate from other lipid abnormalities
Clinical Significance
Elevated Lipoprotein(a), or Lp(a), is an emerging independent risk factor for atherosclerotic cardiovascular disease and calcific aortic valve stenosis. Lp(a) levels are largely genetically determined and not significantly affected by lifestyle modifications, making it a unique lipid biomarker requiring specific screening and targeted therapeutic approaches.
Documentation Requirements
- ✓Provider documentation of elevated Lp(a) as a clinical diagnosis, not just a lab finding
- ✓Lp(a) level with units (nmol/L or mg/dL) and reference range
- ✓Cardiovascular risk assessment in context of elevated Lp(a)
- ✓Family history of premature cardiovascular disease if relevant
- ✓Treatment plan: aspirin, niacin, PCSK9 inhibitors, or emerging antisense therapies
- ✓Screening rationale (personal or family history of atherosclerotic cardiovascular disease)
Commonly Confused Codes
- •E78.00: Pure hypercholesterolemia, unspecified: LDL cholesterol elevation is distinct from Lp(a) elevation
- •E78.49: Other hyperlipidemia: broader category; use E78.41 when Lp(a) is specifically elevated
- •E78.5: Hyperlipidemia, unspecified: too nonspecific when Lp(a) is the documented abnormality
- •R78.79: Finding of abnormal level of heavy metals in blood: incorrect category entirely